Jan Deprest

69 statements · 3 topics · summaries given as host listed separately

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Why do we insist so much on removing the balloon prior to birth? That is mainly because we have seen that both the survival as well as the early morbidity is better if the balloon is removed in utero at least 24 hours prior to birth.

quote · Congenital Diaphragmatic Hernia

I would like to share an experience we had in Europe here with this antenatal intervention for diaphragmatic cornea.

quote · Congenital Diaphragmatic Hernia

There is nothing I can do about that.

quote · Fetal Surgery

Patient selection for FETO is based on lung-to-head ratio (LHR) corrected for gestational age (observed/expected) and presence of liver herniation, with severe hypoplasia defined as maximum 20% survival, moderate 50%, and mild 85% survival.

clinical · Fetal Surgery

There is an apparent decrease in bronchopulmonary dysplasia after FETO, with no evidence of substituting mortality by morbidity based on oxygen need, ventilator days, time to full enteral feeding, and NICU days.

clinical · Pulmonary Hypoplasia

Even with delivery prior to 32 weeks after FETO, survival rate is as high as predicted at term without fetal therapy; for delivery at 32 weeks or later, survival is 60%, which doesn't increase beyond 34 weeks.

clinical · Pulmonary Hypoplasia

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Jan's statements about Congenital Diaphragmatic Hernia 23 statements

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Fetoscopic endoluminal tracheal occlusion and twin-twin transfusion: Fetal...

Quotation I would like to share an experience we had in Europe here with this antenatal intervention for diaphragmatic cornea. Open

Statement Congenital diaphragmatic hernia occurs in 10-20% of monochorionic twin pregnancies and is responsible for large amounts of perinatal mortality and morbidity, with 80-100% mortality if untreated in the past. Open

Statement Patient selection for FETO is based on lung-to-head ratio (LHR) corrected for gestational age (observed/expected) and presence of liver herniation, with severe hypoplasia defined as maximum 20% survival, moderate 50%, and mild 85% survival. Open

Quotation The question for you basically is whether this is still actual. Open

Statement The FETO procedure is done at 26-28 weeks (now 29 weeks in updated protocol) under local anesthesia with fetal analgesia and immobilization, lasting 6-10 minutes on average when fetal position is favorable. Open

Quotation It is a very reasonable procedure. Open

Quotation We really won't like to have a longitudinal position of the baby preferentially because when it is in transverse, it's a very unstable lay and the fetus will be difficult to access. Open

Statement The median gestational age at birth after FETO was 35 weeks, similar to open fetal surgery, with 20-22% experiencing ruptured membranes by 34 weeks. Open

Statement Balloon removal in utero at least 24 hours prior to birth is associated with better survival and early morbidity compared to removal at delivery. Open

Quotation Why do we insist so much on removing the balloon prior to birth? That is mainly because we have seen that both the survival as well as the early morbidity is better if the balloon is removed in utero at least 24 hours prior to birth. Open

Quotation In very rare cases you can pick it up after birth either by puncture percutaneously or by tracheoscopy, but that's really not the recommended way to do. Open

Statement FETO increased survival from around 0% to 20% in the smallest lung group and by 30-35% on average in the severe hypoplasia group compared to historical controls. Open

Statement Independent predictors of survival after FETO are initial lung size prior to operation, gestational age at delivery, and ability to remove balloon in utero at least 24 hours before birth. Open

Statement Even with delivery prior to 32 weeks after FETO, survival rate is as high as predicted at term without fetal therapy; for delivery at 32 weeks or later, survival is 60%, which doesn't increase beyond 34 weeks. Open

Quotation In a very sarcastic way one can say that even if this complication occurs, we don't kill babies by doing an in utero intervention. Open

Quotation There is no reason at this moment to think that we have substituted mortality by morbidity. Open

Statement There is an apparent decrease in bronchopulmonary dysplasia after FETO, with no evidence of substituting mortality by morbidity based on oxygen need, ventilator days, time to full enteral feeding, and NICU days. Open

Statement The TOTAL trial in Europe compares tracheal occlusion at 27-29 weeks to expectant management, with survival as primary outcome in severe cases and survival without BPD in moderate cases. Open

Statement Centers offering FETO must have an active fetoscopy program (minimum 36 interventions per year or 3 per month), experience with 15 balloon occlusion cases (at least 5 done locally), and 24-hour balloon removal capability. Open

Statement In the moderate TTTS trial, 54 cases have been recruited beyond the first interim analysis, with all participating centers agreeing not to offer fetal therapy outside the trial. Open

Quotation We have too long gone on with offering this procedure, still trying to figure out small improvements, while actually we didn't learn from the last 100 cases. Open

Statement The severe FETO trial has been hampered by too long offering the procedure outside trial settings while trying to optimize technique, though the last 100 cases showed no improvement in outcomes. Open

Quotation There is nothing I can do about that. Open

Jan's statements about Fetal Surgery 23 statements

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